Rationalizing artemisinin-based combination therapies use for treatment of uncomplicated malaria: A situation analysis in health facilities and private pharmacies of Douala 5e-Cameroon.

Artemisinin-based combination therapies (ACTs) represent one of the mainstays of malaria control. Despite evidence of the risk of ACTs resistant infections in resource-limited countries, studies on the rational use of ACTs to inform interventions and prevent their emergence and/or spread are limited. The aim of this study was designed to analyze practices toward ACTs use for treating the treatment of uncomplicated malaria (UM) in an urban community. Between November 2015 and April 2016, a cross-sectional and prospective study was conducted in the 6 health facilities and all pharmacies in the Douala 5e subdivision, Cameroon. Anonymous interviews including both open- and closed-ended questions were conducted with selected participants among drug prescribers, patients attending the health facilities, and customers visiting the pharmacies. Data analysis was performed using StataSE11 software (version 11 SE). A total of 41 prescribers were included in the study. All were aware of national treatment guidelines, but 37.7% reported not waiting for test results before prescribing an antimalarial drug, and the main reason being stock-outs at health facilities. Likewise, artemether+lumefantrine/AL (81%) and dihydroartemisinin+piperaquine (63.5%) were the most commonly used first- and second-line drugs respectively. Biological tests were requested in 99.2% (128/129) of patients in health facilities, 60.0% (74) were performed and 6.2% were rationally managed. Overall 266 (35%) of 760 customers purchased antimalarial drugs, of these, 261 (98.1%) agreed to participate and of these, 69.4% purchased antimalarial drugs without a prescription. ACTs accounted for 90.0% of antimalarials purchased from pharmacies, of which AL was the most commonly prescribed antimalarial drug (67.1%), and only 19.5% of patients were appropriately dispensed. The current data suggest a gap between the knowledge and practices of prescribers as well as patients and customers misconceptions regarding the use of ACTs in Douala 5e subdivision. Despite government efforts to increase public awareness regarding the use of ACTs as first-line treatment for UM, our findings point out a critical need for the development, implementation and scaling-up of control strategies and continuing health education for better use of ACTs (prescription and dispensing) in Cameroon.

Deletions of Histidine-Rich Protein 2/3 Genes in Natural Plasmodium falciparum Populations from Cameroon and India: Role of Asymptomatic and Submicroscopic Infections.

The bulk of malaria rapid diagnostic tests (RDTs) target histidine-rich protein 2 of Plasmodium falciparum, the deadliest malaria species. The WHO considers pfhrp2/3 deletions as one of the main threats to successful malaria control and/or elimination; as such, parasites that lack part or all of the pfhrp2 gene are missed by pfHRP2-targeting RDTs. Such deletions have been reported in several African and Asian countries, but little is known in Cameroon and India. Blood samples were collected from individuals living in four areas of Cameroon (Douala, Maroua, Mayo-Oulo, Pette) and India (Mewat, Raipur, Ranchi, Rourkela). Deletions in pfhrp2/3 genes were confirmed if samples 1) had ≥100 parasites/µL by quantitative polymerase chain reaction (PCR), 2) PCR negative for pfhrp2/3, and 3) PCR positive for at least two single-copy genes. The overall proportion of pfhrp2 and pfhrp3 deletions in Cameroon was 13.5% and 3.1%. In India, the overall proportion was 8% for pfhrp2 and 4% for pfhrp3. The overall proportions of samples with both gene deletions (pfhrp2-/3-) were 3.1% in Cameroon and 1.3% in India. In Cameroon, pfhrp2-/3+ and pfhrp2-/3- deletions were common in Maroua (P = 0.02), in asymptomatic parasitemia (P = 0.006) and submicroscopic parasitemia (P <0.0001). In both countries, pfhrp2/3 deletions, including pfhrp2-/3- deletions, were mainly seen in monoclonal infections. This study outlines that double deletions that result in false negative RDTs are uncommon in our settings, and highlights the importance of active molecular surveillance for pfhrp2/3 deletions in Cameroon and India.

Poor quality of sleep and musculoskeletal pains among highly trained and elite athletes in Senegal.

BACKGROUND: Previous studies reported that poor sleep quality (PSQ) was associated with musculoskeletal pains (MSP) and poor physical performance in athletes. OBJECTIVE: The current study aimed at determining PSQ and its associations with MSP in some sub-Saharan athletes. METHODS: A cross sectional study was conducted among 205 highly trained and 115 elite athletes (aged: 25 ± 2 years, Body mass index: 22.8 ± 0.9 kg/m2) in Dakar, Senegal, during a competitive season in a variety of sport disciplines including athletics, basketball, football, rugby, wrestling, tennis. Quality of sleep and MSP were assessed using the French version Pittsburgh Sleep Quality Index (PSQI) and French version of Nordic questionnaire respectively. Pain on body joints during a week was defined as seven-day MSP (MSP-7d) and PSQ for a PSQI > 5. RESULTS: 27.8% (95%CI: 23.2-32.9) of the overall sample suffered PSQ, with 33.7% (95%CI: 24.7-44.0) in basketball and 24.7% (95%CI: 16.9-34.6) in football. According to athletic status and gender, PSQ was more prevalent among highly trained (66.3; 95%CI: 55.9-75.3) and men (69.7%; 95%CI: 59.5-78.7). Among athletes with PSQ 43.8% (95%CI: 33.9-54.2) suffered MSP-7d, with 36.6%; highly trained (95%CI: 23.7-42.9) and 28.1% female. Considering body region, hips/thigh (14.6%; 95% CI: 8.74-23.4) and upper back (13.5%; 95%CI: 7.88 -21, 1) were more affected. Basketball players were more affected from MSP (MSP-7d = 38.5%; 95%CI: 24. 9-54.1) on high on wrists/hands (MSP-7d = 44.4%; 95%CI: 18.9 -73.3; P = 0.04). Based on athletic status, MSP-7d were higher on highly trained necks (100%; 95%CI: 56.1-100; p = 0.04). PSQ was associated with basketball (OR: 3.062, 95%CI: 1.130-8.300, p = 0.02) compared to Athletic. PSQ and MSP-7d were associated on Wrist/hands (OR: 3.352, 95%CI: 1.235-9.099, p = 0.01), and at the upper back (OR: 5.820, 95%CI: 2.096-16.161, p = 0.0007). CONCLUSION: These results indicate that PSQ is considerable among Senegalese athletes and is associated with MSP during a week. Hence, we recommend to look for strategies optimizing good quality of sleep in order to reduce pains, to improve health.

Exploring demographical, clinical, and dietary determinants of vitamin D deficiency among adults in Douala, Cameroon during the COVID-19 era.

Background and aim: Vitamin D deficiency (VDD) is a global public health problem in African populations. This study aimed at determining the prevalence, characteristics, and determinants of VDD in the era of SARS-CoV-2/COVID-19. This study was conducted from January to September 2022 in seven health facilities in Douala, Cameroon. Methods: A structured, pre-tested questionnaire was administered to each participant to collect participants' information. Molecular detection of the SARS-CoV-2 genome was done. A serum level of 25-hydroxyvitamin D < 20 ng/mL was used to diagnose VDD. Results: A total of 420 participants were included in the study. A Serum levels of 25(OH) vitamin D were reduced in SARS-CoV-2 (+) patients as compared to SARS-CoV-2 (-) patients (21.69 ± 5.64 ng/mL vs 42.09 ± 20.03 ng/mL, p < 0.0001). The overall prevalence of VDD was 10.2 %. SARS-CoV-2 (+) individuals had nearly two times more risk of being VDD compared to SARS-CoV-2 (-) individuals (aRR = 1.81, p < 0.0001). The risk of VDD was reduced by 46 % and 71 % in those consuming cocoa bean or powder regularly (aRR = 0.54, p = 0.03) and rarely (aRR = 0.29, p = 0.02) as compared to those never consuming it. Likewise, the risk of VDD was reduced by 59 % and 78 % in those consuming sardine fish regularly (aRR = 0.47, p = 0.002) and rarely (aRR = 0.22, p = 0.03). Overall, the association between VDD and SARS-CoV-2 infection was consistent, i.e., reduced risk of VDD in SARS-CoV-2 (-) individuals, after stratification for confounding variables. Conclusion: This study outlined a high burden of VDD, a strong link between VDD and SARS-CoV-2, and suggests the possible utility of vitamin D supplementation for COVID-19 patients in Cameroon.

Serological surveillance reveals a high exposure to SARS-CoV-2 and altered immune response among COVID-19 unvaccinated Cameroonian individuals.

Surveillance of COVID-19/SARS-CoV-2 dynamics is crucial to understanding natural history and providing insights into the population's exposure risk and specific susceptibilities. This study investigated the seroprevalence of SARS-CoV-2 antibodies, its predictors, and immunological status among unvaccinated patients in Cameroon. A multicentre cross-sectional study was conducted between January and September 2022 in the town of Douala. Patients were consecutively recruited, and data of interest were collected using a questionnaire. Blood samples were collected to determine Immunoglobin titres (IgM and IgG), interferon gamma (IFN- γ) and interleukin-6 (IL-6) by ELISA, and CD4+ cells by flow cytometry. A total of 342 patients aged 41.5 ± 13.9 years were included. Most participants (75.8%) were asymptomatic. The overall crude prevalence of IgM and IgG was 49.1% and 88.9%, respectively. After adjustment, the seroprevalence values were 51% for IgM and 93% for IgM. Ageusia and anosmia have displayed the highest positive predictive values (90.9% and 82.4%) and specificity (98.9% and 98.3%). The predictors of IgM seropositivity were being diabetic (aOR = 0.23, p = 0.01), frequently seeking healthcare (aOR = 1.97, p = 0.03), and diagnosed with ageusia (aOR = 20.63, p = 0.005), whereas those of IgG seropositivity included health facility (aOR = 0.15, p = 0.01), age of 40-50 years (aOR = 8.78, p = 0.01), married (aOR = 0.21, p = 0.02), fever (aOR = 0.08, p = 0.01), and ageusia (aOR = 0.08, p = 0.01). CD4+, IFN-γ, and IL-6 were impaired in seropositive individuals, with a confounding role of socio-demographic factors or comorbidities. Although the WHO declared the end of COVID-19 as a public health emergency, the findings of this study indicate the need for continuous surveillance to adequately control the disease in Cameroon.

Genetic diversity and natural selection of apical membrane antigen-1 (ama-1) in Cameroonian Plasmodium falciparum isolates.

Antigenic variation associated with genetic diversity in global Plasmodium falciparum apical membrane antigen-1 (PfAMA-1) is a major impediment to designing an effective malaria vaccine. Here, we report the first study on genetic diversity and natural selection of the Pfama-1 gene in P. falciparum isolates from Cameroon. A total of 328 P. falciparum positive samples collected during 2016 and 2019 from five localities of Cameroon were analysed. The ectodomain coding fragment of Pfama-1 gene was amplified for polymorphism profiling and natural selection analysis. A total of 108 distinct haplotypes were found in 203 P. falciparum isolates with considerable nucleotide diversity (π = 0.016) and haplotype diversity (Hd = 0.976). Most amino acid substitutions detected were scattered in ectodomain-I and few specific mutations viz P145L, K148Q, K462I, L463F, N471K, S482L, E537G, K546R and I547F were seen only in Cameroonian isolates. A tendency of natural selection towards positive diversifying selection was observed (Taj-D = 2.058). Five positively selected codon sites (P145L, S283L, Q308E/K, P330S and I547F) were identified, which overlapped with predicted B-cell epitopes and red blood cell (RBC) binding sites, suggesting their potential implication in host immune pressure and parasite-RBC binding complex modulation. The Cameroonian P. falciparum populations indicated a moderate level of genetic differentiation when compared with global sequences, with few exceptions from Vietnam and Venezuela. Our findings provide baseline data on existing Pfama-1 gene polymorphisms in Cameroonian field isolates, which will be useful information for malaria vaccine design.

Prevalence and predictors of mortality among hospitalized children with severe acute malnutrition in a hospital in North Cameroon.

BACKGROUND: Severe acute malnutrition (SAM) is a major public health concern responsible for paediatric hospitalizations and more than one-third of deaths across the world. In 2013, SAM caused ≥20% of deaths in severely malnourished infants in Douala, the economic capital of Cameroon. There is little data on SAM in economically, sanitary and socially disadvantaged Cameroonian regions including the North region. OBJECTIVES: To determine the prevalence and potential predictors of mortality among children with SAM in a reference health facility in Garoua, North region, Cameroon. METHODS: A cross-sectional analytical study was conducted from November 2021 to May 2022 at the paediatric ward of Garoua Regional hospital. Data collected on sociodemographic, clinical and therapeutic characteristics in this study were questionnaire based. RESULTS: A total of 6769 children were admitted for hospitalization during the study period, among them 701 SAM cases, giving a hospital prevalence of 10.4%. Of the 347 children included, 51% of the study population were males and 87.6% were children aged 6-23 months. Seven predictors of mortality were identified: orphan status [adjusted odds ratios (AOR) = 8.70, p = 0.021], vomiting (AOR = 3.40, p < 0.0001), marasmus-kwashiorkor (AOR = 7.30, p = 0.005), lack of appetite (AOR = 56.10, p < 0.0001), cutaneous lesions (AOR = 5.50, p = 0.014), lethargy (AOR = 4.50, p = 0.001) and nasogastric rehydration (AOR = 6.50, p = 0.004). CONCLUSION: Practitioners in the northern region of Cameroon should address these locally identified mortality factors to intervene with, and hopefully prevent and adequately manage malnutrition and SAM in this and similar contexts.

Malaria in pregnancy in India: a 50-year bird's eye.

Introduction: In 2021, India contributed for ~79% of malaria cases and ~ 83% of deaths in the South East Asia region. Here, we systematically and critically analyzed data published on malaria in pregnancy (MiP) in India. Methods: Epidemiological, clinical, parasitological, preventive and therapeutic aspects of MiP and its consequences on both mother and child were reviewed and critically analyzed. Knowledge gaps and solution ways are also presented and discussed. Several electronic databases including Google scholar, Google, PubMed, Scopus, Wiley Online library, the Malaria in Pregnancy Consortium library, the World Malaria Report, The WHO regional websites, and ClinicalTrials.gov were used to identify articles dealing with MiP in India. The archives of local scientific associations/journals and website of national programs were also consulted. Results: Malaria in pregnancy is mainly due to Plasmodium falciparum (Pf) and P. vivax (Pv), and on rare occasions to P. ovale spp. and P. malariae too. The overall prevalence of MiP is ~0.1-57.7% for peripheral malaria and ~ 0-29.3% for placental malaria. Peripheral Pf infection at antenatal care (ANC) visits decreased from ~13% in 1991 to ~7% in 1995-1996 in Madhya Pradesh, while placental Pf infection at delivery unit slightly decreased from ~1.5% in 2006-2007 to ~1% in 2012-2015 in Jharkhand. In contrast, the prevalence of peripheral Pv infection at ANC increased from ~1% in 2006-2007 to ~5% in 2015 in Jharkhand, and from ~0.5% in 1984-1985 to ~1.5% in 2007-2008 in Chhattisgarh. Clinical presentation of MiP is diverse ranging from asymptomatic carriage of parasites to severe malaria, and associated with comorbidities and concurrent infections such as malnutrition, COVID-19, dengue, and cardiovascular disorders. Severe anemia, cerebral malaria, severe thrombocytopenia, and hypoglycemia are commonly seen in severe MiP, and are strongly associated with tragic consequences such as abortion and stillbirth. Congenital malaria is seen at prevalence of ~0-12.9%. Infected babies are generally small-for-gestational age, premature with low birthweight, and suffer mainly from anemia, thrombocytopenia, leucopenia and clinical jaundice. Main challenges and knowledge gaps to MiP control included diagnosis, relapsing malaria, mixed Plasmodium infection treatment, self-medication, low density infections and utility of artemisinin-based combination therapies. Conclusion: All taken together, the findings could be immensely helpful to control MiP in malaria endemic areas.

First Insight into Drug Resistance Genetic Markers, Glucose-6-Phosphate Dehydrogenase and Phylogenetic Patterns of Misdiagnosed Plasmodium vivax Malaria in Far North Region, Cameroon.

Plasmodium falciparum (Pf) is the predominant malaria species in Africa, but growing rates of non-falciparum species such as P. vivax (Pv) have been reported recently. This study aimed at characterizing drug resistance genes, glucose-6-phosphate dehydrogenase gene (G6PD), and phylogenetic patterns of a Pv + Pf co-infection misdiagnosed as a Pf mono-infection in the Far North region of Cameroon. Only one non-synonymous mutation in the pvdhps gene A383G was found. Pv drug resistance gene sequences were phylogenetically closer to the reference SAL-I strain and isolates from Southeast Asia and Western Pacific countries. Analyzing co-infecting Pf revealed no resistance mutations in Pfmdr1 and Pfk13 genes, but mutations in Pfcrt (C72V73I74E75T76) and Pfdhfr-Pfdhps genes (A16C50I51R59N108L164 - A436A437K540G581S613) were observed. No G6PD deficiency-related mutations were found. This is first study from Cameroon reporting presence of putative drug resistance mutations in Pv infections, especially in the pvdhps gene, and also outlined the absence of a G6PD-deficiency trait in patients.

Confounding role of comorbidities and COVID-19 vaccination uptake in clinical utility of hematological biomarkers in Cameroonian patients infected with SARS-CoV-2.

Objectives: To analyze variations in blood profile, the extent of hematological disorders, and the impact of comorbidities and COVID-19 vaccination on blood profile parameters and their clinical value for prognostic of SARS-CoV-2 infection. Methods: This cross-sectional study took place in Douala, Cameroon. A complete blood count and molecular detection of SARS-CoV-2 were performed on patients. Clinical value was appraised using area under the curve (AUC) analysis. Results: In total, 420 participants were included. A significant reduction of hematological parameters such as lymphocytes (p < 0.0001), red blood cells (P = 0.0025), mean corpuscular hemoglobin count (P < 0.0001), and platelets (P = 0.02) was seen in SARS-CoV-2 (+) patients. Anisocytosis was the main hematological disorder (95.5%). Normocytic normochromic anemia was predominant in SARS-CoV-2 (+) (35.3%) while microcytic normochromic anemia was more frequently seen in SARS-CoV-2 (-) (16.5%). Neutrophil-to-lymphocyte (NLR) consistently showed statistically significant AUC ∼0.75 upon stratification for age, gender, and comorbidities, with the exception of COVID-19 vaccination uptake. Conclusion: In a context where molecular detection methods are difficultly affordable in health facilities in developing countries such as Cameroon, NLR could be clinically interesting for identifying SARS-CoV-2 infected individuals, especially those with comorbidities.

Effectiveness of Intermittent Preventive Treatment with Sulfadoxine-Pyrimethamine in Pregnancy: Low Coverage and High Prevalence of Plasmodium falciparum dhfr-dhps Quintuple Mutants as Major Challenges in Douala, an Urban Setting in Cameroon.

Intermittent preventive treatment in pregnancy with sulfadoxine and pyrimethamine (IPTp-SP) is a key component in the malaria control strategy implemented in Africa. The aim of this study was to determine IPTp-SP adherence and coverage, and the impact on maternal infection and birth outcomes in the context of widespread SP resistance in the city of Douala, Cameroon. Clinical and demographic information were documented among 888 pregnant women attending 3 health facilities, from the antenatal care visit to delivery. Positive samples were genotyped for P. falciparum gene (dhfr, dhps, and k13) mutations. The overall IPTp-SP coverage (≥three doses) was 17.5%, and 5.1% received no dose. P. falciparum prevalence was 16%, with a predominance of submicroscopic infections (89.3%). Malaria infection was significantly associated with locality and history of malaria, and it was reduced among women using indoor residual spraying. Optimal doses of IPTp-SP were significantly associated with reduced infection among newborns and women (secundiparous and multiparous), but there was no impact of IPTp-SP on the newborn bodyweight. Pfdhfr-Pfdhps quintuple mutants were over-represented (IRNI-FGKAA, IRNI-AGKAA), and sextuple mutants (IRNI-AGKAS, IRNI-FGEAA, IRNI-AGKGS) were also reported. The Pfk13 gene mutations associated with artemisinin resistance were not detected. This study highlights the role of ANC in achieving optimal SP coverage in pregnant women, the mitigated impact of IPTp-SP on malaria outcomes, and the high prevalence of multiple SP-resistant P. falciparum parasites in the city of Douala that could compromise the efficacy of IPTp-SP.

Chemical composition and repellent activity of essential oils of Tithonia diversifolia (Asteraceae) leaves against the bites of Anopheles coluzzii.

Tithonia diversifolia is widely used in African traditional medicine for the treatment of a large number of ailments and disorders, including malaria. In the present study, we evaluated the repellent activity of essential oils (EO) of this plant against Anopheles coluzzii, a major vector of malaria in Africa. Fresh leaves of T. diversifolia were used to extract EO, which were used to perform repellency assays in the laboratory and in the field using commercially available N,N-Diethyl-meta-toluamide (DEET) and Cymbopogon (C.) citratus EO as positive controls and vaseline as negative control. The repellency rates and durations of protection of the human volunteers involved were used as measures of repellent activity. Chemical composition of the T. diversifolia EO was established further by gas chromatography coupled with mass spectrometry. The moisture content and oil yield were 81% and 0.02% respectively. A total of 29 compounds in the T. diversifolia EO was identified, with D-limonene (20.1%), α-Copaene (10.3%) and o-Cymene (10.0%) as the most represented. In field studies, the mean time of protection against mosquito bites was significantly lower in T. diversifolia EO-treated volunteers compared to treatments with C. citratus EO (71 min versus 125 min, p = 0.04), but significantly higher when compared with the non-treated volunteers (71 min vs 0.5 min, p = 0.03). The same pattern was found in laboratory repellency assays against A. coluzzii. In contrast, repulsion rates were statistically similar between T. diversifolia EO and positive controls. In conclusion, the study suggests promising repellent potential of leaves of T. diversifolia EO against A. coluzzii.

Phytofabrication and characterization of Alchornea cordifolia silver nanoparticles and evaluation of antiplasmodial, hemocompatibility and larvicidal potential.

Purpose: The recent emergence of Plasmodium falciparum (Pf) parasites resistant to current artemisinin-based combination therapies in Africa justifies the need to develop new strategies for successful malaria control. We synthesized, characterized and evaluated medical applications of optimized silver nanoparticles using Alchornea cordifolia (AC-AgNPs), a plant largely used in African and Asian traditional medicine. Methods: Fresh leaves of A. cordifolia were used to prepare aqueous crude extract, which was mixed with silver nitrate for AC-AgNPs synthesis and optimization. The optimized AC-AgNPs were characterized using several techniques including ultraviolet-visible spectrophotometry (UV-Vis), scanning/transmission electron microscopy (SEM/TEM), powder X-ray diffraction (PXRD), selected area electron diffraction (SAED), energy dispersive X-ray spectroscopy (EDX), Fourier transformed infrared spectroscopy (FTIR), dynamic light scattering (DLS) and Zeta potential. Thereafter, AC-AgNPs were evaluated for their hemocompatibility and antiplasmodial activity against Pf malaria strains 3D7 and RKL9. Finally, lethal activity of AC-AgNPs was assessed against mosquito larvae of Anopheles stephensi, Culex quinquefasciatus and Aedes aegypti which are vectors of neglected diseases such as dengue, filariasis and chikungunya. Results: The AC-AgNPs were mostly spheroidal, polycrystalline (84.13%), stable and polydispersed with size of 11.77 ± 5.57 nm. FTIR revealed the presence of several peaks corresponding to functional chemical groups characteristics of alkanoids, terpenoids, flavonoids, phenols, steroids, anthraquonones and saponins. The AC-AgNPs had a high antiplasmodial activity, with IC50 of 8.05 µg/mL and 10.31 µg/mL against 3D7 and RKL9 Plasmodium falciparum strains. Likewise, high larvicidal activity of AC-AgNPs was found after 24 h- and 48 h-exposure: LC50 = 18.41 µg/mL and 8.97 µg/mL (Culex quinquefasciatus), LC50 = 16.71 µg/mL and 7.52 µg/mL (Aedes aegypti) and LC50 = 10.67 µg/mL and 5.85 µg/mL (Anopheles stephensi). The AC-AgNPs were highly hemocompatible (HC50 > 500 µg/mL). Conclusion: In worrying context of resistance of parasite and mosquitoes, green nanotechnologies using plants could be a cutting-edge alternative for drug/insecticide discovery and development.

Musculoskeletal pains among amateur and professional athletes of five disciplines in Senegal: a preliminary study.

BACKGROUND: Musculoskeletal pains (MSPs) in sport are cause of poor performances and loss of competition in athletes. The present study aimed at determining the prevalence of MSPs with regard to sport disciplines and athletic status. METHODS: A cross-sectional study was conducted among 320 Senegalese professional and amateur athletes practicing football, basketball, rugby, tennis, athletics, and wrestling. Rates of MSPs in the past year (MSPs-12) and week (MSPs-7d) were assessed using standard questionnaires. RESULTS: Overall proportions of MSPs-12 and MSPs-7d were 70 and 74.2%, respectively. MSPs-12 were more frequently reported on shoulders (40.6%), neck (37.1%) and hips/thigh (34.4%), while MSPs-7d were predominant on hips/thigh (29.5%), shoulders (25.7%), and upper back (17.2%). Proportions of MSPs-12 and MSPs-7d varied significantly by sport disciplines, with highest values among basketball players. Again, highest MSPs-12 proportions on shoulders (29.7%, P = 0.02), wrists/hands (34.6%, P = 0.001), (40.2%, P = 0.0002), and knees (38.8%, P = 0.002) were seen among basketball players. High proportions of MSPs-7d were seen on shoulders (29.6%, P = 0.04) for tennis players, wrists/hands (29.4%, P = 0.03) for basketball and football players, and hips/thigh (38.8%, P < 0.00001) for basketball players. Football players had reduced risk of MSPs-12 by 75% on lower back (OR = 0.25; 95% CI. 0.10-0.63; P = 0.003) and by 72% on knees (OR = 0.28; 95% CI. 0.08-0. 95; P = 0.04). In contrast, tennis players were more at risk of MSPs-12 on shoulders (OR = 3.14; 95% CI. 1.14-8.68; P = 0.02), wrists/hands (OR = 5.18; 95% CI.1.40-11.13; P = 0.01), and hips/thigh (OR = 2.90; 95% CI. 1.1-8.38; P = 0.04). Professionals were protected from MSPs-12 on neck pain with a significant reduction of risk by 61% (OR = 0.39, 95% CI. 0.21-0.75, P = 0.03). CONCLUSION: MSPs are a reality among athletes and their risk is modulated by sport disciplines, athletic status and gender.

Epidemiological situation of SARS-CoV-2 infection in Douala, the most populated and highly heterogeneous town of Cameroon: a post-vaccination update.

This study aimed at providing an update of SARS-CoV-2 epidemiology in Douala, the most populated and highly heterogeneous town of Cameroon. A hospital-based cross sectional study was conducted from January to September 2022. A questionnaire was used to collect sociodemographic, anthropometric, and clinical data. Retrotranscriptase quantitative polymerase chain reaction was used to detect SARS-CoV-2 in nasopharyngeal samples. Of the 2354 individuals approached, 420 were included. The mean age of patients was 42.3 ± 14.4 years (range 21 - 82). The prevalence of SARS-CoV-2 infection was 8.1%. The risk of infection with SARS-CoV-2 was increased more than seven times in patients aged ≥ 70 years old (aRR = 7.12, p = 0.001), more than six times in married (aRR = 6.60, p = 0.02), more than seven times in those having completed secondary studies (aRR = 7.85, p = 0.02), HIV-positive patients (aRR = 7.64, p < 0.0001) and asthmatic patients (aRR = 7.60, p = 0.003), and more than nine times in those seeking health care regularly (aRR = 9.24, p = 0.001). In contrast, the risk of SARS-CoV-2 infection was reduced by 86% in patients attending Bonassama hospital (aRR = 0.14, p = 0.04), by 93% in patients of blood group B (aRR = 0.07, p = 0.04), and by 95% in COVID-19 vaccinated participants (aRR = 0.05, p = 0.005). There is need for ongoing surveillance of SARS-CoV-2 in Cameroon, given the position and importance of Douala.

Post-exercise heart rate variability recovery after 800-m endurance run load among Cameroonian adolescent's males.

The 800-m (m) run is part of Physical Education classes in Cameroon, after which arrhythmias may occur during recovery. Hence, this study aimed at determining relationship between 800-m run loads on cardiac autonomic recovery among school adolescents. Forty-two male adolescents (aged [17 â€‹± â€‹1] years) performed 800-m. Post-exercise heart rate variability (HRV) was recorded during 5-min (min) (HRV5-min) and 15-min (HRV15-min) in time: Standard deviation of normal to normal (SDNN); Root mean square of successive differences (RMSSD) and frequency domain (LH: Low frequency, HF: High frequency, TP: Total power). Rating of Perceived Exertion (RPE) and blood lactate concentration (BLa) were measured after exercise. In HRV5-min, RPE was associated with SDNN (r â€‹= â€‹-0.44, p â€‹< â€‹0.01) and RMSSD (r â€‹= â€‹-0.38, p â€‹< â€‹0.05). BLa was correlated with SDNN (r â€‹= â€‹-0.38, p â€‹< â€‹0.05) and RMSSD (r â€‹= â€‹-0.56, p â€‹< â€‹0.001) in the time-domain, LF (r â€‹= â€‹-0.64, p â€‹< â€‹0.001), HF (r â€‹= â€‹-0.58, p â€‹< â€‹0.001) and TP (r â€‹= â€‹-0.61, p â€‹< â€‹0.001) in frequency-domain. Moreover, RPE was correlated with LF (r â€‹= â€‹-0.44, p â€‹< â€‹0.01), TP (r â€‹= â€‹-0.49, p â€‹< â€‹0.01) while exercise duration with HF (r â€‹= â€‹-0.38, p â€‹< â€‹0.05). In HRV15-min, BLa was correlated with RMSSD (r â€‹= â€‹-0.53, p â€‹< â€‹0.001) and SDNN (r â€‹= â€‹-0.68, p â€‹< â€‹0.001). RPE was negatively correlated SDNN (r â€‹= â€‹-0.53, p â€‹< â€‹0.01) and RMSSD (r â€‹= â€‹-0.44, p â€‹< â€‹0.01). BLa was associated with HF (r â€‹= â€‹-0.55, p â€‹< â€‹0.001), TP (r â€‹= â€‹-0.50, p â€‹< â€‹0.01) and RPE with LF (r â€‹= â€‹-0.51, p â€‹< â€‹0.01), HF (r â€‹= â€‹-0.50, p â€‹< â€‹0.01), TP (r â€‹= â€‹-0.49, p â€‹< â€‹0.01). In addition, exercise duration was negatively linked to HF (r â€‹= â€‹-0.36, p â€‹< â€‹0.05). This study outlined that in untrained adolescents an increase of 800-m loads is associated with a slow vagal indexes of HRV during the recovery.

Non-falciparum species and submicroscopic infections in three epidemiological malaria facets in Cameroon.

BACKGROUND: There are growing reports on the prevalence of non-falciparum species and submicroscopic infections in sub-Saharan African countries but little information is available from Cameroon. METHODS: A hospital-based cross-sectional study was carried out in four towns (Douala, Maroua, Mayo-Oulo, and Pette) from three malaria epidemiological strata (Forest, Sahelian, and Soudanian) of Cameroon. Malaria parasites were detected by Giemsa light microscopy and polymerase chain reaction (PCR) assay. Non-falciparum isolates were characterized and their 18S gene sequences were BLASTed for confirmatory diagnosis. RESULTS: PCR assay detected malaria parasites in 82.4% (98/119) patients, among them 12.2% (12/98) were asymptomatic cases. Three Plasmodium species viz. P. falciparum, P. ovale curtisi and P. vivax, and two co-infection types (P. falciparum + P. vivax and P. falciparum + P. ovale curtisi) were found. The remaining infections were mono-infections with either P. falciparum or P. ovale curtisi. All non-falciparum infections were symptomatic and microscopic. The overall proportion of submicroscopic infections was 11.8% (14/119). Most asymptomatic and submicroscopic infection cases were self-medicated with antimalarial drugs and/or medicinal plants. On analysis, P. ovale curtisi sequences were found to be phylogenetically closer to sequences from India while P. vivax isolates appeared closer to those from Nigeria, India, and Cameroon. No G6PD-d case was found among non-falciparum infections. CONCLUSIONS: This study confirms our previous work on circulation of P. vivax and P. ovale curtisi and the absence of P. knowlesi in Cameroon. More studies are needed to address non-falciparum malaria along with submicroscopic infections for effective malaria management and control in Cameroon.

In vitro antiplasmodial activity, hemocompatibility and temporal stability of Azadirachta indica silver nanoparticles.

Recently green nanotechnology has gained great interest as a promising tool for drug discovery. In the present study, we synthesized and characterized silver nanoparticles (AgNPs) using Azadirachta indica (AI) and evaluated their hemocompatibility and effect against Plasmodium falciparum strains. AI leaves and barks were used for aqueous extracts (AIL and AIB) and AgNPs synthesis. AgNPs were characterized using spectroscopic, diffraction, electron microscopic and electrostatic techniques. Anti-plasmodial and haemolytic activity were assessed following the SYBR Green I fluorescence assay and Miki et al. protocol, respectively. The normalized fluorescence counts were plotted against the log-transformed drug concentration and half-maximal inhibitory concentration (IC50) determined by analyzing the dose-response curves. AgNPs were stored for 120 days at room temperature-RT, +4 °C and -20 °C and subsequently their stability was evaluated by spectroscopy. Both NPs were predominantly spheroidal, crystalline in nature, stable, well dispersed with mean size of 13.01 nm for AIL-NPs and 19.30 nm for AIB-NPs and exhibited good antiplasmodial activity against 3D7 and RKL9 P. falciparum strains with IC50 of 9.27 µg/mL and 11.14 µg/mL for AIL-NPs, 8.10 µg/mL and 7.87 µg/mL for AIB-NPs, respectively. A. indica contain bioactive phyto-compounds indicating great potential for anti-malarial drug development through green nanotechnology. The AgNPs were structurally stable after 120 days but antiplasmodial activity was considerably affected. A significant haemolytic activity (>25%) was observed with AIL- and AIB-AgNPs at concentrations ≥125 µg/mL.

Prevalence, Patterns, and Determinants of Malaria and Malnutrition in Douala, Cameroon: A Cross-Sectional Community-Based Study.

BACKGROUND: Malaria and malnutrition are major public health problems in developing countries. This studywas mainly focused on the prevalence, patterns, and predictors of these conditions and their associations. METHODS: A cross-sectional community study was conducted from February to March 2018 among 281 participants living in two districts in Douala. A questionnaire was used to collect sociodemographic information and parasitological and anthropometric data of participants. Nutritional status was determined using age, weight, and height. Body mass index for age (BMIAZ), height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ) Z scores were computed based on the World Health Organization growth reference curves. Malaria infection was diagnosed using light-emitting diode fluorescence microscopy. RESULTS: The overall prevalence of malaria was 18.9%, mostly asymptomatic cases. Malaria infection was associated with study site (p = 0.04), age (p = 0.01), WAZ (p = 0.0049), HAZ (p = 0.03), and BMI (p = 0.02). The overall prevalence of malnutrition was 43.1%, and stunting was the main form of malnutrition recorded in children under five years of age (23.6%). The risk of being stunted in this group was about quintupled in malaria-infected participants (ARR = 4.70; p = 0.02). In those aged 5-19 years, the prevalence of underweight was significantly higher in malaria-positive individuals as compared to their negative counterparts (p = 0.02). The overall prevalence of malaria and malnutrition cooccurrence was 8.5% and varied with age (p < 0.0001) and study site (p = 0.04). Conclusion and Recommendation. Malaria was associated with malnutrition among the study participants. Early detection and treatment of these ailments would reduce morbidity and mortality.

Field Performances of Rapid Diagnostic Tests Detecting Human Plasmodium Species: A Systematic Review and Meta-Analysis in India, 1990-2020.

Rapid diagnostic tests (RDTs) have become a mainstay of malaria diagnosis in endemic countries since their implementation in the 1990s. We conducted a 30-year systematic review and meta-analysis on malaria RDTs performance in India. Outcomes of interest were sensitivity (Se), specificity (Sp), positive/negative likelihood ratio (PLR/NLR), and diagnostic odd ratio (DOR). Among the 75 studies included, most of the studies were cross-sectional (65.3%), hospital-based (77.3%), and targeted febrile patients (90.6%). Nearly half of RDTs were designed for detecting Plasmodium falciparum only (47.5%) while the rest were for P. falciparum and P. vivax (11.9%), and P. falciparum/Pan-Plasmodium except for P. knowlesi (32.3%). When compared to light microscopy (gold standard), pooled estimates of performances were: Se = 97.0%, Sp = 96.0%, PLR = 22.4, NLR = 0.02 and DOR = 1080. In comparison to polymerase chain reaction, the RDTs showed Se = 89.0% and Sp = 99.0%. Performance outcomes (Se and Sp) were similar for RDT targeting P. falciparum only, but decreased for mixed and non-falciparum infections. Performances of malaria RDTs are still high India. However, there is a need for developing RDTs with regard to targeting minor malarial species, individuals carrying only mature gametocytes, and pfhrp2-deleted parasites.